Epicondylar and transphyseal elbow fractures in children
- Leticia Manning Ryan, MD, MPH, FAAP
Leticia Manning Ryan, MD, MPH, FAAP
- Assistant Professor of Pediatrics
- Division of Emergency Medicine
- Johns Hopkins Children's Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Epicondylar elbow fractures most commonly occur in older boys after a fall on an outstretched arm [1-3]. Medial epicondylar fractures comprise 10 percent of all elbow fractures in children. Many of these fractures may be managed with splinting and early active motion. However, surgery is required in children with open fractures, bony fragments that are incarcerated in the elbow joint, or complete ulnar nerve deficit. Lateral epicondylar fractures are rare and do not require surgical intervention [3,4].
Transphyseal fractures are relatively uncommon fractures seen in infants and young children. They are associated with child abuse and birth trauma. Proper orthopedic treatment typically requires closed reduction with percutaneous pinning. Diagnosis of a transphyseal elbow fracture in a child with no plausible mechanism of injury should prompt involvement of an experienced child protection team (eg, social worker, nurse, physician with more extensive experience in the management of child abuse), if available, and reporting of suspected child abuse to proper authorities, as required.
This topic review addresses epicondylar and transphyseal elbow fractures in children. Supracondylar and condylar elbow fractures are discussed separately. (See "Evaluation and management of supracondylar fractures in children" and "Evaluation and management of condylar elbow fractures in children".)
Medial epicondylar fractures comprise approximately 10 percent of elbow fractures in children . These fractures are much more common in boys than girls. Age of occurrence ranges from 9 to 14 years. Falls account for most of these fractures . Case reports also describe medial epicondylar fractures occurring after throwing a baseball and arm wrestling in boys [5,6]. Fifty percent of medial epicondyle fractures are associated with a posterior elbow dislocation, so elbow stability must be evaluated [7,8].
Fractures of the lateral epicondyle are unusual and typically arise from a fall on an outstretched hand or a direct blow .
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- PERTINENT ANATOMY
- MECHANISM OF INJURY
- Epicondylar fracture
- Distal transphyseal fractures
- PHYSICAL FINDINGS
- RADIOGRAPHIC FINDINGS
- Epicondylar fractures
- Transphyseal fractures
- INITIAL TREATMENT
- Orthopedic consultation
- Child protection
- DEFINITIVE CARE
- Medial epicondylar fractures
- Lateral epicondylar fractures
- Transphyseal fracture
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Epicondylar fractures
- Distal humeral transphyseal fractures